Small left atrial volume is an independent predictor for fainting during head-up tilt test: The impact of intracardiac volume reserve in vasovagal syncope

Jeonggeun Moon; Jaemin Shim; Jae Hyung Park; Hye Jin Hwang; Boyoung Joung; Jong Won Ha; Moon Hyoung Lee; Hui Nam Pak

doi:10.1016/j.ijcard.2011.09.076

Small left atrial volume is an independent predictor for fainting during head-up tilt test: The impact of intracardiac volume reserve in vasovagal syncope

Jeonggeun Moon, Jaemin Shim, Jae Hyung Park, Hye Jin Hwang, Boyoung Joung, Jong Won Ha, Moon Hyoung Lee, Hui Nam Pak

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

8 Citations (Scopus)

Abstract

Background: Vigorous left ventricular (LV) contraction with progressive ventricular emptying during orthostatic stress may induce hyper-responsiveness of cardiac mechanoreceptor and vasovagal syncope (VVS). We hypothesized that intracardiac volume reserve estimated by the left atrial (LA) volume index (LAVI) plays an important role in the mechanism of VVS. Methods: A total of 234 patients (115 male, 44 ± 18 years) who underwent head-up tilt test (HTT) and transthoracic echocardiography for unexplained syncope were consecutively enrolled. Patients with a positive HTT result (HTT+; n = 152) were compared with those with negative HTT response (HTT-; n = 82). Results: 1. Compared to HTT- patients, HTT+ patients were younger (41 ± 17 vs. 48 ± 17 years, p = 0.005), included a higher number of females (56% vs. 50%, p = 0.009) and showed higher basal heart rate (67 ± 12 vs. 63 ± 11 bpm, p = 0.047). 2. LAVI (20 ± 5 vs. 26 ± 13 ml/m², p < 0.001), LV end-diastolic dimension (47.4 ± 3.7 vs. 49.0 ± 4.1 mm, p = 0.015), and the proportion of LV hypertrophy (13% vs. 24%, p = 0.027) were smaller and early diastolic mitral annulus velocity was higher (9.7 ± 3.0 vs. 8.5 ± 2.6 cm/s, p = 0.004) in HTT+ patients than those in HTT- group. 3. LAVI (OR 0.917 (0.860-0.977), p = 0.007) was the only independent predictor of HTT induced VVS, and LAVI had a linear correlation with time to syncope during HTT (r = 0.39, p = 0.034). In addition, patients with LAVI ≥ 36 ml/m² did not faint during HTT. Conclusion: Small LA volume is an independent predictor of HTT-induced VVS. Limited intracardiac volume reserve might play an important role in the mechanism of VVS.

Original language	English
Pages (from-to)	44-49
Number of pages	6
Journal	International Journal of Cardiology
Volume	166
Issue number	1
DOIs	https://doi.org/10.1016/j.ijcard.2011.09.076
Publication status	Published - 2013 Jun 5

Bibliographical note

Funding Information:
The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology. This work was supported by a grant of the Korea Health 21 R&D Project ( A085136 ), Ministry of Health and Welfare , and Basic Science Research Program under the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology ( 2010-0010537 ), Republic of Korea. We also would like to thank the Research Affairs Department of Yonsei University College of Medicine for excellent assistance in statistical analysis.

All Science Journal Classification (ASJC) codes

Cardiology and Cardiovascular Medicine

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10.1016/j.ijcard.2011.09.076

Cite this

@article{cac1e80b10684995bdaec5e5d601629a,

title = "Small left atrial volume is an independent predictor for fainting during head-up tilt test: The impact of intracardiac volume reserve in vasovagal syncope",

abstract = "Background: Vigorous left ventricular (LV) contraction with progressive ventricular emptying during orthostatic stress may induce hyper-responsiveness of cardiac mechanoreceptor and vasovagal syncope (VVS). We hypothesized that intracardiac volume reserve estimated by the left atrial (LA) volume index (LAVI) plays an important role in the mechanism of VVS. Methods: A total of 234 patients (115 male, 44 ± 18 years) who underwent head-up tilt test (HTT) and transthoracic echocardiography for unexplained syncope were consecutively enrolled. Patients with a positive HTT result (HTT+; n = 152) were compared with those with negative HTT response (HTT-; n = 82). Results: 1. Compared to HTT- patients, HTT+ patients were younger (41 ± 17 vs. 48 ± 17 years, p = 0.005), included a higher number of females (56% vs. 50%, p = 0.009) and showed higher basal heart rate (67 ± 12 vs. 63 ± 11 bpm, p = 0.047). 2. LAVI (20 ± 5 vs. 26 ± 13 ml/m2, p < 0.001), LV end-diastolic dimension (47.4 ± 3.7 vs. 49.0 ± 4.1 mm, p = 0.015), and the proportion of LV hypertrophy (13% vs. 24%, p = 0.027) were smaller and early diastolic mitral annulus velocity was higher (9.7 ± 3.0 vs. 8.5 ± 2.6 cm/s, p = 0.004) in HTT+ patients than those in HTT- group. 3. LAVI (OR 0.917 (0.860-0.977), p = 0.007) was the only independent predictor of HTT induced VVS, and LAVI had a linear correlation with time to syncope during HTT (r = 0.39, p = 0.034). In addition, patients with LAVI ≥ 36 ml/m2 did not faint during HTT. Conclusion: Small LA volume is an independent predictor of HTT-induced VVS. Limited intracardiac volume reserve might play an important role in the mechanism of VVS.",

author = "Jeonggeun Moon and Jaemin Shim and Park, {Jae Hyung} and Hwang, {Hye Jin} and Boyoung Joung and Ha, {Jong Won} and Lee, {Moon Hyoung} and Pak, {Hui Nam}",

note = "Funding Information: The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology. This work was supported by a grant of the Korea Health 21 R&D Project ( A085136 ), Ministry of Health and Welfare , and Basic Science Research Program under the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology ( 2010-0010537 ), Republic of Korea. We also would like to thank the Research Affairs Department of Yonsei University College of Medicine for excellent assistance in statistical analysis.",

year = "2013",

month = jun,

day = "5",

doi = "10.1016/j.ijcard.2011.09.076",

language = "English",

volume = "166",

pages = "44--49",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

number = "1",

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TY - JOUR

T1 - Small left atrial volume is an independent predictor for fainting during head-up tilt test

T2 - The impact of intracardiac volume reserve in vasovagal syncope

AU - Moon, Jeonggeun

AU - Shim, Jaemin

AU - Park, Jae Hyung

AU - Hwang, Hye Jin

AU - Joung, Boyoung

AU - Ha, Jong Won

AU - Lee, Moon Hyoung

AU - Pak, Hui Nam

N1 - Funding Information: The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology. This work was supported by a grant of the Korea Health 21 R&D Project ( A085136 ), Ministry of Health and Welfare , and Basic Science Research Program under the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology ( 2010-0010537 ), Republic of Korea. We also would like to thank the Research Affairs Department of Yonsei University College of Medicine for excellent assistance in statistical analysis.

PY - 2013/6/5

Y1 - 2013/6/5

N2 - Background: Vigorous left ventricular (LV) contraction with progressive ventricular emptying during orthostatic stress may induce hyper-responsiveness of cardiac mechanoreceptor and vasovagal syncope (VVS). We hypothesized that intracardiac volume reserve estimated by the left atrial (LA) volume index (LAVI) plays an important role in the mechanism of VVS. Methods: A total of 234 patients (115 male, 44 ± 18 years) who underwent head-up tilt test (HTT) and transthoracic echocardiography for unexplained syncope were consecutively enrolled. Patients with a positive HTT result (HTT+; n = 152) were compared with those with negative HTT response (HTT-; n = 82). Results: 1. Compared to HTT- patients, HTT+ patients were younger (41 ± 17 vs. 48 ± 17 years, p = 0.005), included a higher number of females (56% vs. 50%, p = 0.009) and showed higher basal heart rate (67 ± 12 vs. 63 ± 11 bpm, p = 0.047). 2. LAVI (20 ± 5 vs. 26 ± 13 ml/m2, p < 0.001), LV end-diastolic dimension (47.4 ± 3.7 vs. 49.0 ± 4.1 mm, p = 0.015), and the proportion of LV hypertrophy (13% vs. 24%, p = 0.027) were smaller and early diastolic mitral annulus velocity was higher (9.7 ± 3.0 vs. 8.5 ± 2.6 cm/s, p = 0.004) in HTT+ patients than those in HTT- group. 3. LAVI (OR 0.917 (0.860-0.977), p = 0.007) was the only independent predictor of HTT induced VVS, and LAVI had a linear correlation with time to syncope during HTT (r = 0.39, p = 0.034). In addition, patients with LAVI ≥ 36 ml/m2 did not faint during HTT. Conclusion: Small LA volume is an independent predictor of HTT-induced VVS. Limited intracardiac volume reserve might play an important role in the mechanism of VVS.

AB - Background: Vigorous left ventricular (LV) contraction with progressive ventricular emptying during orthostatic stress may induce hyper-responsiveness of cardiac mechanoreceptor and vasovagal syncope (VVS). We hypothesized that intracardiac volume reserve estimated by the left atrial (LA) volume index (LAVI) plays an important role in the mechanism of VVS. Methods: A total of 234 patients (115 male, 44 ± 18 years) who underwent head-up tilt test (HTT) and transthoracic echocardiography for unexplained syncope were consecutively enrolled. Patients with a positive HTT result (HTT+; n = 152) were compared with those with negative HTT response (HTT-; n = 82). Results: 1. Compared to HTT- patients, HTT+ patients were younger (41 ± 17 vs. 48 ± 17 years, p = 0.005), included a higher number of females (56% vs. 50%, p = 0.009) and showed higher basal heart rate (67 ± 12 vs. 63 ± 11 bpm, p = 0.047). 2. LAVI (20 ± 5 vs. 26 ± 13 ml/m2, p < 0.001), LV end-diastolic dimension (47.4 ± 3.7 vs. 49.0 ± 4.1 mm, p = 0.015), and the proportion of LV hypertrophy (13% vs. 24%, p = 0.027) were smaller and early diastolic mitral annulus velocity was higher (9.7 ± 3.0 vs. 8.5 ± 2.6 cm/s, p = 0.004) in HTT+ patients than those in HTT- group. 3. LAVI (OR 0.917 (0.860-0.977), p = 0.007) was the only independent predictor of HTT induced VVS, and LAVI had a linear correlation with time to syncope during HTT (r = 0.39, p = 0.034). In addition, patients with LAVI ≥ 36 ml/m2 did not faint during HTT. Conclusion: Small LA volume is an independent predictor of HTT-induced VVS. Limited intracardiac volume reserve might play an important role in the mechanism of VVS.

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Small left atrial volume is an independent predictor for fainting during head-up tilt test: The impact of intracardiac volume reserve in vasovagal syncope

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